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Biomedical subjects

W Rock

Publications and source records attributed to W Rock.

14 recordsLinked to original sources
PubMed2006

Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial.

AIMS: To compare selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT), in terms of intraocular pressure (IOP) lowering, in patients with open-angle glaucoma. METHODS: 176 eyes of 152 patients were enrolled in this study, 89 in the SLT and 87 in the ALT groups. Patients were randomised to receive either SLT or ALT treatment to 180 degrees of the trabecular meshwork. Patients were followed up to 12 months after treatment. The main outcome measured was IOP lowering at 12 months after treatment, compared between the SLT and ALT groups. RESULTS: No significant difference (p = 0.846) was found in mean decrease in IOP between the SLT (5.86 mm Hg) and ALT (6.04 mm Hg) groups at 1 year or at any other time points, nor were there any significant differences in the rate of early or late complications between the two groups. CONCLUSIONS: SLT is equivalent to ALT in terms of IOP lowering at 1 year, and is a safe and effective procedure for patients with open-angle glaucoma.

Aged↗
PubMed2005

Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: results from a randomised clinical trial.

BACKGROUND/AIMS: The efficacy and safety of selective laser trabeculoplasty (SLT) has been found to be equivalent to argon laser trabeculoplasty (ALT). Since SLT produces significantly less disturbance to the trabecular meshwork and is theoretically more repeatable than ALT, it has potential to replace ALT as the standard procedure to treat medically uncontrolled open angle glaucoma. This study's objective is to determine factors that predict successful SLT at 1 year post-treatment. METHODS: As part of a randomised clinical trial comparing the efficacy and safety of SLT to ALT, data on 72 SLT patients were collected, and successful SLT defined as having an SLT induced intraocular pressure (IOP) reduction of >or=20% at 1 year post-treatment follow up. RESULTS: 43 out of the 72 patients who had completed their 1 year follow up visit had an IOP reduction of >or=20% from baseline. No glaucoma risk factors studied predicted successful SLT. The amount of trabecular meshwork pigmentation was not a significant predictor. However, it was discovered that baseline IOP strongly predicted SLT success (odds ratio=1.16; p=0.0001). CONCLUSION: SLT success was significantly predicted by baseline IOP but not by age, sex, other glaucoma risk factors, type of open angle glaucoma, or by degree of trabecular meshwork pigmentation.

Adult↗
PubMed2004

Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients.

Although the risk factors for acquiring infection by extended-spectrum beta-lactamase (ESBL)-producing bacteria have been investigated in hospitalized patients, such risk factors have not been defined in the community setting. In this study, clinical data from a total of 311 nonhospitalized patients with community-acquired urinary tract infection (128 with ESBL-positive strains and 183 with ESBL-negative strains) were obtained. According to a multivariate analysis, the following were identified as independent risk factors: previous hospitalization in the past 3 months (OR=8.95, 95%CI, 3.77-21.25), antibiotic treatment in the past 3 months (OR=3.23, 95%CI, 1.76-5.91), age over 60 years (OR=2.65, 95%CI, 1.45-4.83), diabetes (OR=2.57, 95%CI, 1.20-5.51), male gender (OR=2.47, 95%CI, 1.22-5.01), Klebsiella pneumoniae infection (OR=2.31, 95%CI, 1.17-4.54), previous use of third-generation cephalosporins (P=0.014, OR=15.8, 95%CI, 1.7-143), previous use of second-generation cephalosporins (P<0.0001, OR=10.1, 95%CI, 4.2-24), previous use of quinolones (P=0.001, OR=4.1, 95%CI, 1.8-9.0), and previous use of penicillin (P=0.003, OR=4.0, 95%CI, 1.6-9.0).

Adolescent↗
PubMed1999

Childhood-onset primary open angle glaucoma in a Canadian kindred: clinical and molecular genetic features.

OBJECTIVE: To describe the clinical features and identify the molecular etiology of childhood-onset primary open angle glaucoma (POAG) in a Canadian kindred. METHODS: Members of a Canadian Caucasian family with POAG were examined and DNA obtained. Single-strand conformation polymorphism analysis was performed using reported primers from exon 3 of the myocilin gene. A single-stranded conformation polymorphism was characterized by polymerase chain reaction-based sequencing. RESULTS: Two affected half-sibs had onset of severe glaucoma at age 3 and 9. Their mother had lost vision in one eye from glaucoma by age 17. All three affected subjects had undergone bilateral glaucoma filtering surgery. Both fathers were unaffected. A single-stranded conformation polymorphism was identified in the mother and the two affected daughters and was absent in one father. A single base change from C-->T at nucleotide position 1109 was identified in the affected members of the family by direct sequencing. This mutation, which causes a nonconservative amino acid change (Pro370Leu), was not found on 192 normal chromosomes from Caucasian individuals. CONCLUSION: We report a Canadian family with childhood-onset, severe POAG due to a mutation in the myocilin gene.

Adult↗
PubMed1998

Workshop: Credentialing of Anticoagulation Providers: A Proposed Model.

The winter 1997 survey of Anticoagulation Forum members identified a strong desire for an anticoagulation provider certification program. The Anticoagulation Provider Certification Working Group (APCWG) is a multidisciplinary committee formed (1) to develop the objectives and process required to achieve the competencies for anticoagulation therapy providers, (2) to propose a framework for a national certification process that validates achievement of anticoagulation therapy provider competencies, and (3) to create a reproducible educational framework for all clinicians involved with anticoagulation therapy. The APCWG assessed the need for credentialing the levels of mastery expected of anticoagulation providers, identified key elements of a certification program, assessed published anticoagulation provider competencies, studied elements of a successful regional credentialing program, proposed core anticoagulation domains of knowledge and associated competencies, and solicited and incorporated broad-based multidisciplinary feedback on such domains and competencies. As a result, the APCWG has developed a draft of five knowledge domains: physiology/pathophysiology of thromboembolic disorders, patient assessment and management, patient education, pharmacology of antithrombotic agents, and operational processes surrounding the coordinated care of an anticoagulated patient. These draft domains of knowledge and the accompanying list of detailed competencies were distributed to all attendees of the May 1997 Anticoagulation Forum Meeting for review and feedback. The plan is to incorporate comments and revise the documents, develop and pilot a certification process, and present the results of the pilot(s) to a national organization to serve as a foundation of a valid and accepted national certification process.

Journal Article↗
PubMed1996

Effect of ciprofloxacin on the pharmacokinetics and pharmacodynamics of warfarin.

To determine if ciprofloxacin therapy alters the response to warfarin treatment, 36 adult patients attending three university-affiliated outpatient anticoagulation clinics randomly received a 12-day course of ciprofloxacin (750 mg twice daily) and a 12-day course of placebo; each course was separated by a 2-week washout period. Prothrombin times (PTs), concentrations of S-warfarin and R-warfarin (the isomers of warfarin), and concentrations of clotting factors II and VII were determined three times weekly for 9 weeks. By day 12 of ciprofloxacin therapy, concentrations of S-warfarin remained unchanged compared with those after placebo therapy, but R-warfarin concentrations increased significantly (1.15 times those after placebo therapy; P = .001); concentrations of clotting factors II and VII decreased (0.903 and 0.872 times those after placebo therapy, respectively, P < or = .020). The mean PT ratio after 12 days of ciprofloxacin therapy increased slightly (1.032 times that after placebo therapy; P = .057), but no patient had bleeding or a change in PT that required alteration in warfarin or ciprofloxacin therapy. We conclude that warfarin therapy is not a contraindication to the use of ciprofloxacin.

Adult↗
PubMed1995

How to fire a physician.

How does one fire a physician? In a word, carefully! Most of the legal protections for other employees apply just as well to physicians. And physicians have access to an expanded realm of protections because of the nature of their profession and because of its role in the health care delivery system. The ordinary employee cannot raise antitrust; the fired physician may very well raise just that issue. And yet the need to terminate a physician will sometimes, even though rarely, occur. How can the organization be certain that it has treated the physician fairly, has documented any and all offenses in a defensible fashion, and has generally followed accepted practices in all aspects of dealing with the physician? The author provides some guidelines for dealing with the problem or the incompetent physician.

Civil Rights↗
PubMed1988

Intraocular pressure reduction prior to retrobulbar injection of anesthetic.

Following the retrobulbar injection of anesthetic, the application of a mechanical device to lower the intraocular pressure will produce a rise in intraocular pressure that may be sufficient to compromise ocular perfusion. To increase the margin of safety for ischemic damage, a mechanical means of intraocular pressure reduction (Superpinkie) was applied prior to, rather than following, the retrobulbar injection of anesthetic. The study group consisting of 20 patients receiving the compression-injection sequence had a mean preoperative pressure of 4.70 mm Hg, while a control group of 20 patients receiving the injection-compression sequence had a mean preoperative pressure of 2.25 mm Hg. The proposed compression-injection method was well tolerated by the patients and attained surgically adequate anesthesia, akinesia, and ocular opening pressures. In selective cases, the compression-injection technique for the delivery of retrobulbar anesthesia may offer a means of better maintaining ocular perfusion and thereby lessening the risk of vascular compromise.

Anesthesia, Local↗
PubMed1988

Warfarin dosage predictions assisted by the analog computer.

This paper describes an analog computer program used to predict warfarin dosages following an initial three daily doses of 10 mg. The program simulates the patient's response to warfarin and suggested dosages can be entered into the program daily to predict the dose necessary for the patient. Warfarin dosage predictions were made for 29 patients. There was a statistically significant correlation between predicted prothrombin time (PT) response and actual PT response (p less than 0.005) for all predictions made. However, when actual and predicted responses were compared with a paired t test, they were significantly different (p less than 0.05). The program described here has been useful for predicting initial warfarin requirements for the majority of patients. Continued research is necessary to identify useful computer methods for predicting warfarin dosages.

Computers, Analog↗
PubMedDate not supplied

Physician support groups in a multispecialty group practice setting.

With a moderate expenditure of time and energy on the part of a physician executive, the group support concept can be used in any organization to help physicians overcome social obstacles and learn to cope with the disturbing changes that are occurring in medicine. By selecting the most suitable candidates, anticipating obstacles, and simply beginning an effort, one can bring about optimal change for physician members of an organization despite their apparent reluctance. The optimal time for suggesting help in this group support manner is when the problem is acute and significant, i.e., "a crisis."

Group Practice↗
PubMedDate not supplied

Prescription for physician executives: take care of your doctors.

Considerable attention is paid to employee assistance plans in business and medical groups. Successful plans have improved employee retention, productivity, and morale. But physicians tend to resist these plans, because inherent in a physician's egostructure is a perception that physicians do not need support. In assessing unrest among the doctors in our clinic, it seems to me that our physicians clearly need tender, loving care. This article is a summary of areas in which care can be usefully provided.

Employee Grievances↗
PubMedDate not supplied

Performance evaluations of physician executives. Interview by Barbara J. Linney.

Six senior physician executives were interviewed to see how they were doing or not doing performance reviews in their organizations. There seems to be a trend toward doing them, but it is in the beginning stages. Of the physician executives surveyed, the experience ranges from formal lengthy evaluations with rating scales to reviewing a short list of goals. Several are in the process of developing new systems or revising old ones. Probably the most useful part of a performance evaluation is the conversation between the physician executive and the person he or she reports to. If you can stop approaching performance evaluations as passing negative judgments on people, but as having a conversation to hear their concerns, learn what their goals are, and offer ways to help them achieve their potential, they can be useful, enjoyable experiences for both people.

Employee Incentive Plans↗